This case study is based on a major Southeast Chicago hospital. Providing care for over 110 years, they treat more than 90,000 patients each year with expertise in more than 50 specialties. This includes advanced heart attack care, primary stroke care center, an oncology center, and an array of surgical specialties not found in most community hospitals.
EXECUTIVE SUMMARY
It’s possible for hospitals to realize Return on Investment (ROI), value, and improve the relationship with EMS through the simple act of reliably answering radio and phone calls for EMS ambulance pre-arrival notification and medical direction. A major hospital, located in Southeast Chicago IL, recognized the concerns that many hospital emergency departments have about their relationship and interaction with EMS and the potential influence it has on revenue, patient care, and satisfaction. This case study demonstrates how the implementation of a technology solution addressed these concerns in a positive way by:
- Improving EMS call handling processes and best practices that influence ambulance handoff of high revenue generating patients.
- Becoming known as “The hospital that answers calls”.
- Creating a win-win-win situation for the hospital, EMS, and the patient.
- Demonstrating strong value and ROI for CAREpoint workstation and CAREpoint Remote Control technology solutions.
- Setting the stage for e-Bridge secure messaging and mobile telemedicine app as a force multiplier in EMS-ED communications and information exchange.
THE CHALLENGE
In midst of the hustle and bustle of the typical hospital emergency department (ED), staff may miss incoming radio and phone calls for pre-arrival notification and medical direction from Emergency Medical Services (EMS) ambulances. This is relevant because these calls provide important information about the patient being transported. The omission of this seemingly simple task has the potential to affect not only revenue for both the hospital and EMS agency but patient care and satisfaction as well. All attributes that are important to hospital administrations.
For lower level acuity issues, a concise notification message or call may be all that is needed. For more serious issues and where medical direction is required, a notification is not enough and a timely voice contact is required. Depending on call volume, hospitals may elect to dedicate nursing staff for handling EMS calls as a primary function. Commonly, this is not the case at this hospital, where nursing staff handle both EMS calls and patientcare. The challenge was to implement a full featured communications system with technology and best practices to meet these needs. One which creates an environment whereby EMS, as a valued partner, is incentivized to bring in patients where handoff and care is expeditious. This is a win-win-win situation for the hospital, EMS, and the patient.
“This significantly improved responsiveness in answering and assisting on calls between the EMS crews”
Michele Kroeger, BSN, RN, CEN
EMS/Emergency Management Coordinator.
Revenue Loss From Missed Calls
The average percentage of EMS ambulance arrivals that get admitted to the hospital is more than tripple that of walk-in patients (39 percent vs 12.5 percent) nationally. At this hospital the difference is likely higher. As admitted patients account for a significant portion of hospital revenue, these high value EMS patients are important to administrators.
When an ambulance arrives at the hospital unannounced because a notification call was not made or answered, the ED is not as prepared as it could be to receive that patient. This can result in delays in getting an ED bed ready, gathering the appropriate staff, and additional time to transfer or handoff the patient from EMS to ED. Extra time spent waiting at the hospital is additional time that the ambulance unit is out of service and unavailable to respond to the next emergency, thereby decreasing the ambulance service’s utilization efficiency and therefore its bottom line.
The effect on revenue loss to a hospital in the case of formal diversion or bypass due to bed availability or resources is well understood. Informally, EMS may have a choice or influence in selecting the destination hospital in regions with multiple hospitals of similar transport time and capabilities. In the case of high value patients, it is in the best interest of hospitals to ensure that they are the destination of choice and not their competitor down the road. Missed EMS calls happen and they can be very costly to both EMS and the hospital.
Effects on Patient Care and Satisfaction
A patient from a 911 call that is transported by EMS to the ED is often an emergency and time is of the essence. This is especially true in cases of a heart attack, stroke, or trauma. Performing emergency patient care in the field, selecting the appropriate hospital, and a timely ambulance transport is just the first phase in the continuum of patient care.
For patient care to be most efficient once it hits the emergency department doors, the hospital needs to be prepped and ready. Whether simply identifying what ED bed will be used, alerting the nursing staff, paging a specialist or medical team, or prepping the Cath Lab, early notification by EMS and prompt answering of the calls is a necessity to avoid wasting precious time. Delays in care can affect patient outcomes, as well as patient satisfaction and overall experience. These are all important factors that can be mitigated through improved call handling and communications.
THE SOLUTION
To address the challenge, the Hospital implemented a Responsive Innovation solution from GD that included their CAREpoint 2.0 workstation. This system utilizes advanced calling features that streamline handling of communications between EMS and hospital emergency departments over both 2-way radio and telephone. In addition to simplifying user operation for nurses and physicians, the CAREpoint’s advanced alerting features, along with recording and documenting of all calls and data into its database, facilitate a continuous quality improvement and medical-legal documentation mechanism.
Success at the hospital was in due to relocating the CAREpoint to the Charge Nurse Workstation and also implementation of the new Remote Control app feature of CAREpoint. The CAREpoint-RC app offers the ability for a nurse or physician to answer and handle calls from an iPhone or iPad anywhere on the hospitals wireless network away from the workstation. At the hospital, CAREpoint-RC runs on an iPad that the EMS Coordinator can monitor. “This significantly improved responsiveness in answering and assisting on calls from EMS crews” said Michele Kroeger, BSN, RN, CEN EMS/Emergency Management Coordinator at the hospital. This was such a significant improvement that, “We are now known affectionately by EMS as the hospital that always answers calls.” adds Kroeger.
In addition to being able to step in during periods of increased volume where calls may have otherwise been missed, Kroeger now has the capability to monitor live communications between nurses and EMS teams, thereby being able to track workflow needed and ensure optimal care.
An additional technology available to further improve communications, workflow and patient care for both EMS and hospitals, is GD’s e-Bridge “app” which provides secure notification and Mobile Telemedicine. e-Bridge integrates with CAREpoint and enables hospitals to share HIPAA-secure text notifications and calls with pictures, video, and medical data directly with EMS crews which can add a new dimension to patient care and hospital preparation prior to the ambulance arrival. An emergency department can also use e-Bridge for live ETA tracking to better anticipate ambulance arrival, as well as relay pre-arrival information with responding specialty physicians, such as cardiologists and neurologists, right to their mobile devices.
“We are now known affectionately by EMS as the hospital that always answers calls.””
Michele Kroeger, BSN, RN, CEN
EMS/Emergency Management Coordinator.
RESULTS
On average, the percentage of EMS ambulance arrivals that get admitted to the hospital is more than tripple that of walk-in patients (39 percent vs 12.5 percent). As admitted patients account for a significant portion of hospital revenue, EMS patients are very important to hospital administrators.
Calls from emergency medical services to the emergency department are important for workflow, patient handoff and best practices to all involved. Missed EMS calls happen and they can be costly to both EMS and the hospital. This is in addition to less tangible effects on patient care and satisfaction downstream.
As a busy emergency department, the hospital addressed the issue of missed EMS calls by maximizing utility of the CAREpoint workstation and introducing the CAREpoint-RC app in their emergency department. Through these Responsive Innovation technology solutions from GD, The hospital positioned itself as “The hospital that answers calls”, demonstrating very strong value and ROI for CAREpoint.
Reduction of missed calls and notifications from EMS through technology, process improvement, and best practices have positive bottom-line effects for both EMS and hospitals. Additional future gains may be realized by implementing GD’s e-Bridge secure messaging and mobile telemedicine app as a force multiplier in EMS-ED communications and information exchange.
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